Opinion: Crime contributes directly to the obesity epidemic in Trenton
Nothing is more important to the people of Trenton than our children. Recently, the Public Health Management Corporation released findings from the Philadelphia Adverse Childhood Experiences (ACE) study that linked childhood experiences with growth and development. The study connects specific behaviors and health outcomes in adults to their childhood experiences.
To competently address the health care needs of our families, adults and children, we need to fully understand the unique risk factors and ramifications faced by children who grow up in an inner city. With this in mind, the Henry J. Austin Health Center has embraced the ACE study, which points to a powerful statistical relationship between our emotional experiences as children and our subsequent physical and mental health and neurological development as adults.
With 17,000 participants, the ACE study is one of the largest research projects ever conducted to assess the relationship between stressful or traumatic (adverse) childhood experiences (ACEs) such as abuse, neglect, witnessing domestic violence, growing up with alcohol or other substance abuse, mental illness, parental discord, crime in the home or maltreatment and later-life health and well-being.
The findings are striking and reveal that ACEs lead to increased risk of depression, heart disease and risky sexual behavior. Furthermore, the more ACEs, the greater the likelihood of experiencing alcoholism, chronic obstructive pulmonary disease, depression, fetal death, illicit drug use, heart disease, liver disease, risk for intimate partner violence, sexually transmitted diseases, smoking, obesity, suicide attempts and unintended pregnancies.
Two specific areas to which the ACE studies have sensitized us are crime and obesity. At first glance, these two areas would seem to be separate and unrelated, but we have learned that is not the case. Obesity kills more people than guns in the United States, causing an estimated 300,000 deaths annually.
In Trenton, we have an obesity epidemic, especially among our youth, in large part because of crime. According to a Trenton Health Initiative Community Needs Assessment, “In 2001, approximately 39 percent of Trenton’s residents are obese, compared with 19.7 percent in Mercer County and 23.7 percent in New Jersey” as a whole. Reported childhood statistics are even more alarming, with nearly one in two Trenton children being overweight or obese. The most striking statistics show that the largest difference between Trenton public school children and children nationwide occurs among the youngest children, with 49 percent being overweight or obese in Trenton compared with 21 percent in the U.S.
The long-term health ramifications of childhood obesity are numerous and well-documented. There is increasingly strong evidence that many health issues such as diabetes and hypertension appear much sooner than expected, and abnormal glucose tolerance occurs with increased frequency in obese children.
There is a direct link between crime and health in Trenton. Trenton residents pay a psychological and emotional price for the daily stress they endure because of crime in the city. The result is that they adopt too many health-risk behaviors that lead to disease and disability and, in too many cases, to premature death.
A variety of factors contribute to Trenton’s staggering crime rate. They include high levels of poverty and drug addiction, a proliferation of gangs and a dramatically reduced police force. Municipal budget cuts make the city more dangerous for our children, as they increase health risks in many areas of life, such as a sedentary lifestyle, lack of access to fresh produce, meats and dairy and lack of participation in the school lunch program. Moreover, businesses and vendors are disinclined to set up shop in high-crime settings, making it difficult for children to have access to healthy space and healthy food.
Crime contributes directly to the obesity epidemic in Trenton. There are few safe places where children can play in Trenton. Without exercise, it’s hard for children to burn off calories they consume from eating unhealthy foods. In the letter to the editor “Crime and obesity stalk Trenton’s children” (July 15, 2013), Dr. Ruth Perry, executive director of the Trenton Health Team, succinctly describes the connection between crime and obesity: “Crime impacts many areas of a child’s life, including education and exercise. Trenton children attend school at the risk of gang activities and must walk home under police protection for the same reason. Vice in Trenton parks leaves children with no place for active play. The safety concerns that keep residents indoors fuel Trenton’s obesity epidemic, which hits city children particularly hard.”
The vast array of problems that arise from adverse childhood experiences calls for an integrated medical approach that avoids identifying and approaching medical issues separately and categorically. At HJAHC, we understand and are informed by the ACE research and, as a result, we use an integrated medical approach that considers medical, social and environmental issues when treating our patients, especially the children.
Dr. Kemi Alli is chief medical officer at the Henry J. Austin Health Center in Trenton.
About the Trenton Health Team
Trenton Health Team (THT) is an alliance of the city’s major providers of healthcare services including Capital Health, St. Francis Medical Center, Henry J. Austin Health Center and the city’s Health Department. In collaboration with residents and the city’s active social services network, THT is developing an integrated healthcare delivery system to transform the city’s fragmented primary care system and restore health to the city. THT aims to make Trenton the healthiest city in the state. Support for the Trenton Health Team was provided in part by a grant from The Nicholson Foundation. For more information, visit www.trentonhealthteam.org.